Elderberry

Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD — GMJ Editorial Board

What is Elderberry?

Elderberry refers to the dark purple berries of the European elder tree (Sambucus canadensis or Sambucus nigra), a flowering plant in the Adoxaceae family. These small, tart berries have been used for centuries in traditional medicine across Europe and North America. Today, elderberry is commonly available as a dietary supplement in various forms including syrups, gummies, capsules, and liquid extracts.

The berries are rich in anthocyanins, flavonoids, and other bioactive compounds that give them their distinctive dark color and potential health benefits. While elderberries can be consumed as food when properly cooked, raw elderberries and other parts of the elder plant contain compounds that can be toxic and should be avoided.

Health benefits & uses

Immune system support (Moderate evidence): Several clinical studies suggest elderberry may help reduce the duration and severity of cold and flu symptoms. A systematic review found that elderberry supplementation significantly reduced upper respiratory symptoms, though study quality varied.

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Antioxidant activity (Moderate evidence): Elderberries contain high levels of anthocyanins and other phenolic compounds that demonstrate strong antioxidant properties in laboratory studies. These compounds may help protect cells from oxidative stress and inflammation.

Heart health (Limited evidence): Some preliminary research suggests elderberry may support cardiovascular health by improving cholesterol levels and reducing inflammation markers, but more human studies are needed to confirm these effects.

Blood sugar management (Limited evidence): Early research indicates elderberry might help improve insulin sensitivity and glucose metabolism, but clinical evidence remains insufficient to make definitive recommendations.

How it works

Elderberry’s potential health effects are primarily attributed to its rich concentration of anthocyanins, particularly cyanidin-3-glucoside and cyanidin-3-sambubioside. These compounds exhibit anti-inflammatory and antioxidant properties that may support immune function.

Research suggests elderberry may work by inhibiting viral replication, particularly influenza viruses, and by modulating immune system responses. The anthocyanins may also help strengthen blood vessel walls and reduce oxidative stress throughout the body. Additionally, elderberry appears to influence cytokine production, potentially helping to regulate inflammatory responses during illness.

Dosage

There is no established Recommended Daily Allowance (RDA) or Upper Limit (UL) for elderberry, as it is classified as a dietary supplement rather than an essential nutrient. Typical adult dosing ranges include:

• Standardized extract: 300-600 mg daily
• Syrup: 1-2 tablespoons (15-30 mL) daily
• For acute illness: Some studies used higher doses (up to 600 mg four times daily) for short periods

Dosing varies significantly between products and manufacturers. Always follow package directions and consult with a healthcare provider before starting supplementation, especially if you plan to use elderberry for specific health concerns or alongside other medications.

Food sources

Elderberries are not commonly consumed as fresh fruit due to their tart taste and potential toxicity when raw. Food sources of elderberry include:

• Cooked elderberries: Used in jams, jellies, and pies
• Elderberry syrup: Homemade or commercial preparations
• Elderberry wine: Traditional fermented beverage
• Elderflower products: Teas and cordials made from elder flowers

Most people obtain elderberry through dietary supplements rather than food sources, as the berries require proper preparation to be safe for consumption.

Safety & side effects

Elderberry supplements are generally well-tolerated by most adults when used appropriately. However, several safety considerations exist:

Common side effects: Mild digestive upset, nausea, or diarrhea may occur, particularly with higher doses.

Raw elderberry toxicity: Uncooked elderberries, bark, leaves, and seeds contain cyanogenic glycosides that can cause nausea, vomiting, and diarrhea. Only consume properly processed elderberry products.

Allergic reactions: Though rare, some individuals may experience allergic reactions to elderberry supplements.

Interactions

Drug interactions: Elderberry may potentially interact with immunosuppressive medications, diabetes medications, and diuretics. The theoretical concern exists that elderberry’s immune-stimulating effects could counteract immunosuppressive drugs.

Supplement interactions: No significant interactions with other dietary supplements have been well-documented, but caution is advised when combining with other immune-supporting supplements.

Always inform your healthcare provider about all supplements you’re taking to avoid potential interactions.

Who should be cautious

Certain individuals should exercise caution or avoid elderberry supplementation:

• Pregnant and breastfeeding women: Insufficient safety data available
• People with autoimmune conditions: Elderberry may stimulate immune activity
• Individuals on immunosuppressive therapy: May interfere with treatment
• Children: Limited safety data; pediatric use should be supervised by healthcare providers
• Those with diabetes: May affect blood sugar levels

Frequently asked questions

Can elderberry prevent colds and flu?

While elderberry may help reduce the duration and severity of cold and flu symptoms, there’s insufficient evidence to claim it prevents illness. It’s best viewed as a supportive supplement rather than a preventive treatment.

How long can I take elderberry supplements?

Most studies have examined short-term use (days to weeks). Long-term safety data is limited, so it’s advisable to consult healthcare providers for extended use beyond a few weeks.

Is elderberry safe for children?

While some elderberry products are marketed for children, safety data is limited. Always consult with a pediatrician before giving elderberry supplements to children, and ensure any products are specifically formulated for pediatric use.

Can I take elderberry with other vitamins?

Elderberry generally doesn’t have known interactions with standard vitamins and minerals. However, combining multiple immune-supporting supplements may have additive effects, so moderation is advised.

What’s the difference between elderberry and elderflower?

Elderberry refers to the dark purple fruits of the elder tree, while elderflower comes from the white flowers. Both have traditional medicinal uses, but elderberry is more commonly studied for immune support.